Incidence Of Arterial Hypertension Research Articles

Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up. Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008-2010) and again at first follow-up (2012-2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension. Brazil. Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35-74 years at baseline (2008-2010). UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time. The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus

INTRODUCTION Cocaine abuse is a relevant public health issue which causes medical, psychological and social drawbacks. Only limited data are currently available on outcomes of acute coronary syndromes (ACS) in cocaine-addicted patients. The aim of this study was to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry, with a focus on in-hospital outcomes. METHODS We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 1 January 2007 to 31 December 2018. Baseline and in-hospital data of ACS patients with self-reported regular cocaine abuse were compared with the remaining AMIS Plus population and a sex and age-matched group of non-cocaine user ACS patients (ratio 1:5, 540 patients). Primary endpoints were in-hospital death and major adverse cardiac and cardiovascular events (MACCEs). RESULTS A total of 20,036 patients were included in the AMIS Plus registry for ACS in the study period, of whom 110 (0.5%) reported regular cocaine abuse. As compared with the remaining AMIS population, cocaine users were significantly younger (46.4 ± 10.8 vs 66.4 ± 13.2 years, p <0.001), presented more frequently with out-of-hospital cardiac arrest (11.8% vs 4.7%, p <0.001) and ST-elevation myocardial infarction (68.2% vs 54.7%, p = 0.007). Of the traditional cardiovascular risk factors, there was a higher incidence of positive family history and active smoking, but a lower incidence of arterial hypertension, diabetes and obesity. In-hospital mortality (3.6% vs 4.4%, p = 1) and MACCEs (5.4% vs 5.5%, p = 0.83) were comparable. When compared with an age-matched non-cocaine user ACS population, cocaine users were more frequently smokers (87.6% vs 63.6%, p <0.001) but less frequently obese (10.4% vs 25.6%, p = 0.001). Clinical presentation was comparable between the two groups. However, cocaine abuse was associated with a higher incidence of in-hospital death (3.7% vs 0.7%, p <0.05) and MACCEs (5.6% vs 1.3%, p <0.05). CONCLUSION Cocaine abuse increases the risk of mortality by a factor of 5 and the risk of major adverse cardiac and cardiovascular events by a factor of 4 as compared with a sex and age-matched population hospitalised after an acute coronary syndrome.

Assessment of the professional community awareness about innovative diets prescribed for hypertension

Due to the fact of constantly increasing incidence of arterial hypertension and the large role of nutrition in the treatment and prevention of this disease, the assessment of the awareness of the medical community and patients about the trends in the development of therapeutic and prophylactic diets is relevant. The aim of the research was to assess the physician and patient awareness on the trends in the development of therapeutic and prophylactic diets and different rations prescribed for hypertension prevention. Material and methods. On the SurveyMonkey platform, questionnaires were created for different medical specialties and patient of various departments. Access to the survey was free, the mailing list was carried out through the professional communities of physicians on the Internet. In turn, the doctors-respondents were asked to distribute the link for patients among those who were undergoing treatment or were on dispensary observation for the pathology of the cardiovascular system. Respondents were asked about their attitudes, knowledge, and compliance with existing dietary guidelines. The number of respondents was 300 doctors of various specialties and 300 patients. Results. The most recognizable dietary recommendations among patients were: low-calorie (41.1%), low-carbohydrate (39.4%), vegetarian (39.0%). However, the most popular (the commitment to them was the greatest) were: low in calories (27.6%), low in carbohydrates (25.6%), low in fat (24.4%). Among the doctors, the distribution was as follows - in addition to the classic therapeutic and prophylactic diets prescribed for certain diseases, the most recognizable diets were: Mediterranean (59.8%), low-calorie (59.0%), low-fat (57.3%); and the most commonly prescribed: Mediterranean (47.0%), low-carb (44.4%), low-fat (40.2%). The most recognizable dietary pattern among patients was the low-calorie diet (adherence to it was also maximum). As for physicians, the most recognized and most recommended preventively was the Mediterranean eating pattern. At the same time, the prevalence and recognition of the DASH diet, which, according to the opinion of the world community, has the most pronounced preventive and therapeutic properties, according to the survey, was low (7.3% of the respondents were aware of this diet). Conclusions. According to the results of this work, it is necessary to consider the possibility of combining three diets (low-calorie, Mediterranean and DASH diets) to achieve the maximum therapeutic and preventive effect while maintaining popularity among patients.

Особенности взаимосвязи реоэнцефалографических показателей и суточного профиля артериального давления при артериальной гипертензии у женщин в климактерическом периоде

The incidence of arterial hypertension (AH) in women increases significantly with the onset of menopause. Age-related hypoestrogenism leads both to an increase in blood pressure (BP) and to a violation of its daily profile. It can lead to impaired cerebral blood flow. Objective: to study the features of cerebral disorders in women in the perimenopausal period with and without hyper-tension using rheoencephalography, as well as their relationship with some indicators of the daily blood pressure profile. Materials and methods. A clinical and instrumental examination of 190 women in the climacteric period (141 people with hypertension and 49 without hypertension) was carried out, who were divided into groups depending on the presence of hypertension and the period of perimenopause. Instrumental research included 24-hour blood pressure monitoring and rheoencephalography. Results. The onset of menopause was accompanied by an increase in the degree of arterial hypertension, with an in-crease mainly in systolic blood pressure. Changes in its daily profile was also noted, especially insufficient or excessive de-crease at night, as well as an increased speed and magnitude of the morning rise both in women with hypertension and without it. The revealed disorders were more pronounced in postmenopausal women and were accompanied by changes in cerebral circulation, which can lead to ischemic and hemorrhagic cerebral complications. Conclusion. Comparison of indicators of rheoencephalography and daily monitoring of blood pressure in menopausal women revealed changes in cerebral circulation, most pronounced in the presence of arterial hypertension and after meno-pause.

Epidemiology of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: identification of the most accurate estimates from a systematic literature review.

This systematic review of literature and online reports critically appraised incidence and prevalence estimates of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension to identify the most accurate estimates. Medline® and Embase® databases were searched for articles published between 1 January 2003 and 31 August 2020. Studies were grouped according to whether they were registries (population-based estimates), clinical databases (hospital-based estimates) or claims/administrative databases. Registries were classified into systematic and non-systematic registries, according to whether every national centre participated. Of 7309 publications identified, 5414 were screened after removal of duplicates and 33 were included. Inclusion was based on study type, availability of a clear numerator (diagnosed population) and a population- or hospital-based denominator, or all primary data required to calculate estimates. Only the most recent publication from a database was included. Most studies were based on European data and very few included children. In adults, the range of estimates per million was approximately 20-fold for pulmonary arterial hypertension incidence (1.5–32) and prevalence (12.4–268) and of similar magnitude for chronic thromboembolic pulmonary hypertension incidence (0.9–39) and prevalence (14.5–144). Recent (≤5 years) national systematic registry data from centralised healthcare systems provided the following ranges in adult estimates per million: approximately 5.8 for pulmonary arterial hypertension incidence, 47.6–54.7 for pulmonary arterial hypertension prevalence, 3.1–6.0 for chronic thromboembolic pulmonary hypertension incidence and 25.8–38.4 for chronic thromboembolic pulmonary hypertension prevalence. These estimates were considered the most reliable and consistent for the scientific community to plan for resource allocation and improve detection rates.

Impact of Sars-Cov-2 Infection in Hematopoietic Transplant Patients: Experience from the Madrid Group

Peter Paschka and Hartmut Döhner contributed equally.Background. SARS-CoV-2 infection (COVID-19) has had a great impact worldwide and its mortality has been reported to be higher in patients with haematological malignancies. However, description of its effects and outcomes among recipient of hematopoietic stem cell transplantation (HSCT) is scarce.Objectives. To describe the characteristics, treatment and outcome of COVID-19 in recipients of HSCT reported to the Madrid registry of COVID-19 (“HEMATO-MADRID COVID-19 registry”).Results. Data of 842 patients from 23 hospitals with haematological malignancies and COVID-19 infection were reported in the Madrid registry between March and June 2020. Among those, 87 (10.3%) patients were HSCT recipients: 58 auto-HSCT and 29 allo-HSCT (7 of them from matched related donor (MRD), 12 matched unrelated donor (MUD) and 10 haplo-HSCT). Characteristics of the population are described in Table 1. Median age at COVID-19 infection was 61 years (IQR, 53-67) and 35 patients (40%) were female. Recipients of auto-HSCT with COVID-19 were older and showed a trend towards a higher incidence of arterial hypertension (28% vs 10%, p=0.067) without statistical differences in other comorbidities; active disease requiring treatment at COVID-19 diagnosis was more frequent in auto-HSCT recipients (65% vs. 21%, p<0.001). Median time from transplant to COVID19 infection was shorter in allo-HSCT patients (32 vs. 19 months, p=0.043). Nearly 40% of allo-recipients had active GVHD at COVID-19 debut, including pulmonary GVHD. A total of 63 (72%) patients required hospital admission and 13 patients (15%) received intensive care support. Allo-recipients showed a trend towards a higher need of hospital admission (79% vs. 68%, p=0.081). Most patients received anti-viral treatment with either hydroxichloroquine (47 patients, 54%), lopinavir/ritonavir (34 patients, 39%), remdesivir (5, 4%) and/or other treatments including azythromicin or interferon. 23 patients (26%) received anticytokine treatment with tocilizumab (15, 17%) and/or anakinra (8, 9%) and 27 patients (31%) received steroids. The overall response rate to treatment and supportive care was 80% in both groups. After a median follow-up of 50 days after the infection debut, overall-survival at day 50 was 84% for auto and 82% for allo-HSCT recipients (p=0.915). However, global mortality rate among the complete observation period was significantly higher in allo-recipients (24% vs. 17%, p <0.001).Conclusion. In our multicentric experience in a high COVID-19 impacted area, the median time of COVID-19 infection presentation was relatively late in transplanted patients, however shorter in allo-transplanted patients. COVID-19 related mortality was high in HSCT recipients, significantly higher in allo-transplanted patients. Factors associated to this higher mortality should be further investigated to promptly identify high-risk patients since the pandemic is still highly active worldwide.DisclosuresKwon:Gilead: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Jazz: Consultancy, Honoraria. Duarte:Incyte Corporation: Other: Has received speaker and advisor fees. Hernandez-Rivas:Rovi: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees. Jimenez Yuste:NovoNordisk: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Grifols: Honoraria, Research Funding; Bayer: Honoraria; Sobi: Consultancy, Honoraria, Research Funding; CSL: Honoraria; Octapharma: Honoraria.

The influence of aircraft noise exposure on the systemic and renal haemodynamics.

Epidemiological studies found a link between aircraft noise exposure and increased incidence of arterial hypertension and cardiovascular disease, but the underlying pathophysiological mechanisms are not fully understood. Clinical studies have shown that mental stress affects the systemic and renal haemodynamic, but no such study was performed with noise exposure as stress factor. We analysed systemic and renal effects of 25 min standardized aircraft noise in a sham controlled clinical study including 80 healthy men and 34 male patients with hypertension. Systemic haemodynamic parameters were measured using electrocardiography and impedance cardiography. The renal haemodynamic was assessed using steady state input clearance with infusion of para-aminohippuric acid and inulin for glomerular filtration rate and renal plasma flow, respectively. In the systemic circulation of hypertensive patients, there was an increase in total peripheral resistance (TPR) (1420 ± 387 vs. 1640 ± 516 dyn·s·cm-5, P = 0.001) and a decrease in cardiac index (CI) (2.9 ± 0.8 vs. 2.6 ± 0.8 L/(min·m2, P < 0.001) 25 min after the start of noise exposure, which was not present during sham procedure (P = 0.10, P = 0.86). In healthy individuals a procedure induced increase in TPR and decrease in CI was present after noise (TPR: 995 ± 239 vs. 1106 ± 308 dyn·s·cm-5, P = 0.001, CI: 3.6 ± 0.7 vs. 3.3 ± 0.9 L/(min·m2, P < 0.001) and sham application (TPR: P = 0.002, CI: P < 0.001). However, in healthy individuals changes in TPR (P = 0.450) and CI (P = 0.605) from baseline until 25 min after the start of the intervention did not differ between noise and sham exposure. In the renal circulation of hypertensive patients and healthy individuals the response did not differ between noise and sham procedure. In hypertensive but not healthy men we observed a systemic vasoconstrictive response after aircraft noise exposure accompanied by a decrease in CI. No significant changes were observed in the renal circulation. Our results suggest that male hypertensive patients are more susceptible for noise-induced changes of vascular resistance in the systemic circulation.

Is “one size fits all” anti-aggregation really effective? Variability in the response to P2Y12 receptor inhibitors in obese patients

Abstract Background Different “ex vivo” studies have shown both a greater platelet activation and higher rates of resistance to clopidogrel in obese patients. Although there is less evidence, less prasugrel activity has also been observed in these patients. Our aim was to study the variability of the response to clopidogrel, ticagrelor and prasugrel in obese patients, defined as a body mass index ≥30. Methods Prospective, multicenter, observational, pharmacodynamic study, conducted in a Spanish population of patients with an acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and double anti-aggregation with acetylsalicylic acid and a P2Y12 receptor inhibitor. Platelet function tests were performed the morning after the ICP and 30 days after it, including: 1) VerifyNow P2Y12 assay; 2) multiple electrode aggreometry (Multiplate); and 3) VASP analysis. Results Of the total patients included (988), 300 were obese (30.3%). The obese group was younger (62.8±12 years vs 64.9±12), had a higher incidence of arterial hypertension (76.3% vs. 56.7%), diabetes mellitus (35% vs. 27.5%); and lower incidence of chronic kidney disease (7.7% vs. 17%). There were no differences in the acute phase (day 1 after PCI) in the pharmacodynamic response to any of the P2Y12 inhibitors used. After 30 days, greater platelet aggregation (decreased response) was documented in obese patients treated with prasugrel according to VASP tests (PRI in non-obese 23.9±13% vs. 30.4±14.7% in obese, p 0.035) and MEA (area under the aggregation units curve in non-obese 251.7±104.1 vs 320±166.7 in obese, p 0.007) and a numerical trend with VerifyNow. A trend in the same direction was also observed in patients treated with clopidogrel that did not reach statistical significance with all the platelet function tests used. No differences were observed in the ticagrelor group. Conclusion Obese patients with an ACS treated with PCI have a worse response to thienopyridines than non-obese patients in the maintenance phase of antiaggregant treatment, while the response to ticagrelor is not affected by obesity. Completing the clinical follow-up proposed by the registry is necessary to know if these differences have an implication in cardiovascular events. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fondo de Investigaciones Sanitarias (FIS)

Leadless pacemaker for patients following cardiac valve intervention

Permanent pacing is common after valve intervention. The presence of a conventional pacemaker in this population is recognized as a risk factor for infectious events. Therefore, a leadless pacing system could be the preferred strategy when permanent pacing is required after valve intervention. To report periprocedural outcomes and follow-up of patients undergoing implantation of a leadless pacing system after valve intervention. Patients with previous valve intervention at the time of attempted implantation of a leadless pacemaker (Micra™, Medtronic, Minneapolis, MN, USA) were included, and were compared with a control group (patients also implanted with Micra™ without valve intervention). Among a total of 170 Micra™ implantation procedures, 54 patients (31.8%) had a history of valve intervention: 28 after aortic valve replacement; 10 after mitral valve replacement; one after single tricuspid valvuloplasty; and 15 after multiple valve surgery. Median age of the patients was 82.5 (77.0-86.0) years and 53.7% were male. Patients with previous valve intervention had a higher incidence of arterial hypertension (P=0.014) and ischaemic heart disease (P=0.040). The primary indications for permanent pacing after valve intervention were high-degree atrioventricular block (59.3%) and atrial fibrillation with bradycardia (27.8%). Micra™ was successfully implanted in all patients (n=170) without any procedure-related major complications. During a median follow-up of 12 months, electrical performance was excellent and similar in both groups. Also, a similar reduction in left ventricular ejection fraction was observed at 12 months in both groups, which was correlated with the percentage of right ventricular pacing. A leadless pacemaker is safe and efficient after valve intervention, and therefore represents an effective pacing option in patients after valve intervention.

Association Between Chronic Diseases, Sports Participation And Obesity: Findings From A Brazilian Longitudinal Study

PURPOSE: To analyze the association between leisure-time physical activity (specifically sports participation), obesity and the incidence of chronic diseases among Brazilian adults. METHODS: The sample was composed of 620 adults (166 males and 454 females) aged 50 years or older followed from 2010 to 2014 in the city of Bauru, Sao Paulo, Brazil. Physical activity was assessed using a questionnaire (Baecke et al. Am J Clin Nutr, 1982 [face-to-face interview]) and subjects were stratified according to the engagement in sports in leisure-time (180 minutes/week over the last four months) as: Engaged (n= 99) and Non-engaged (n= 521). Body mass index (kg/m2) was used as diagnosis of obesity (BMI ≥30). Sports participation and obesity were combined and participants were stratified as follow: Obese/Non-sport (n= 230), Obese/Sport (n= 33), Non-obese/Non-sport (n= 291) and Non-obese/Sport (n= 66). The incidence of new cases of arterial hypertension, dyslipidemia and diabetes mellitus were verified through medical records. Chi-squared test for linear trend analyzed associations and statistical significance was set as p-value <5%. RESULTS: The incidence of arterial hypertension was not associated with the combination of sports participation and obesity (p-value= 0.853). However, the incidence of new cases of dyslipidemia (Obese/Non-engaged [37.8%], Obese/Engaged [30.3%], Non-obese/Non-engaged [27.8%] and Non-obese/Engaged [22.7%]; p-value= 0.004) and diabetes mellitus (Obese/Non-engaged [15.2%], Obese/Engaged [12.1%], Non-obese/Non-engaged [8.6%] and Non-obese/Engaged [6.1%]; p-value= 0.006) were associated with the lack of sports participation and obesity. CONCLUSION: There was an association between non-engagement in sports, obesity, and the incidence of dyslipidemia and diabetes mellitus among Brazilian adults. This finding highlight the importance of public health actions promoting healthy behaviors aiming the prevention of chronic diseases, especially in countries with universal health systems. Supported by the Sao Paulo Research Foundation (FAPESP), process number: 2018/01744-7 and CAPES.

Arterial hypertension after heart transplantation

Aim To evaluate incidence of arterial hypertension (AH) in the posttransplantation period and to identify risk factors for this complication.Materials and methods From January, 2010 through December, 2017, 96 heart transplantations (HT) (70 men and 26 women aged 46.5±13.9 years) were performed. During the first month following HT, 8 recipients died and were excluded from the analysis. The retrospective evaluation of results included 88 patients followed up for more than one year.Results For the entire post-HT period (maximum 92 months), AH was observed in 75 of 88 (85%) recipients. Post-HT AH was correlated with male gender (r=0.24; p=0.031), history of smoking before HT (r=0.45; p&lt;0.001), history of ischemic heart disease (IHD) (r=0.28; p=0.01), older age (r=0.35; p=0.001), higher body weight index (r=0.37; p=0.0005), creatinine level (r=0.37; p=0.001), and low-density lipoprotein cholesterol level (r=0.27; p=0.04). Interrelations with other AH risk factors were not found. Most patients developed AH within the first two years after HT. During the first year, AH was diagnosed in 60% (53 of 88) of patients (relapse, 85% (n=29); newly diagnosed, 45% (n=24), p=0.0003). At two years, AH was detected in 79% (46 of 58) of patients (relapse, 53% (n=18); newly diagnosed, 53% (n=28), p=0.9). All recipients received an adequate antihypertensive therapy. 40-63% of patients required a single-drug therapy at different points of follow-up; from 29 to 45% of patients required a two-drug therapy, and 5-15% of patients required three or more drugs. During all 5 years of treatment, most patients used angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (70-87%) and slow calcium channel blockers (SCCB) (48-53%). The presence of AH following HT was associated with development of all cardiovascular events (CVE; r=0.31; p=0.012) whereas persistent AH, which required a combination antihypertensive treatment, was associated with a high mortality (r=0.61; p=0.015).Conclusion AH is a frequent complication of HT (85%), which is newly diagnosed in most patients during the first two years. AH incidence was higher for male recipients with a history of IHD, hypertension, and smoking. Approximately half of patients required only a single-drug antihypertensive therapy. After HT, the most frequently prescribed drugs included ACE inhibitors or ARBs and SCCBs (70-87% and 48-53%, respectively, depending on the time elapsed after HT). Persistent AH requiring a treatment with two or more antihypertensive drugs was associated with development of all CVEs and a higher long-term mortality.

Environmental aircraft noise aggravates oxidative DNA damage, granulocyte oxidative burst and nitrate resistance in Ogg1–/– mice

Background: Large epidemiological studies point towards a link between the incidence of arterial hypertension, ischaemic heart disease, metabolic disease and exposure to traffic noise, supporting the role of noise exposure as an independent cardiovascular risk factor. We characterised the underlying molecular mechanisms leading to noise-dependent adverse effects on the vasculature and myocardium in an animal model of aircraft noise exposure and identified oxidative stress and inflammation as central players in mediating vascular and cardiac dysfunction. Here, we studied the impact of noise-induced oxidative DNA damage on vascular function in DNA-repair deficient 8-oxoguanine glycosylase knockout (Ogg1–/–) mice.Methods and results: Noise exposure (peak sound levels of 85 and mean sound level of 72 dB(A) applied for 4d) caused oxidative DNA damage (8-oxoguanine) and enhanced NOX-2 expression in C57BL/6 mice with synergistic increases in Ogg1–/– mice (shown by immunohistochemistry). A similar pattern was found for oxidative burst of blood leukocytes and other markers of oxidative stress (4-hydroxynonenal, 3-nitrotyrosine) and inflammation (cyclooxygenase-2). We observed additive impairment of noise exposure and genetic Ogg1 deficiency on endothelium-independent relaxation (nitroglycerine), which may be due to exacerbated oxidative DNA damage leading to leukocyte activation and oxidative aldehyde dehydrogenase inhibition.Conclusions: The finding that chronic noise exposure causes oxidative DNA damage in mice is worrisome since these potential mutagenic lesions could contribute to cancer progression. Human field studies have to demonstrate whether oxidative DNA damage is also found in urban populations with high levels of noise exposure as recently shown for workers with high occupational noise exposure.

Sympathetic hyperactivation and sleep apnea syndrome

Nocturnal sleep apnea syndrome (obstructive sleep apnea syndrome) is the cause of many cardiovascular diseases and sudden cardiac death, and also increases the risk of adverse outcomes, in particular acute cardiovascular events (stroke, myocardial infarction and sudden cardiac death). This syndrome is also associated with an increased risk of heart failure. In clinical studies, there is a strong connection between night apnea syndrome and the prevalence and incidence of arterial hypertension, including resistance.Sympathetic hyperactivation and activation of the renin-angiotensin-aldosterone system are common pathogenetic mechanisms for the development of obstructive sleep apnea syndrome and arterial hypertension. Therefore, the best strategy for antihypertensive therapy in the combination of these clinical conditions is the appointment of beta-blockers. Preference should be given to highly selective β1-adrenergic blockers (bisoprolol) with a high safety profile demonstrated in clinical trials.

Myocardial deformation and parameters of diastolic function of the left ventricle in workers of coal mining enterprises in the South of Kuzbass with arterial hypertension

Introduction. Long-term persistent hypertension can lead to heart failure. The study of its early markers, which include diastolic dysfunction of the left ventricle and reduction of longitudinal myocardial deformation, is of importance for workers engaged in harmful and dangerous working conditions.The aim of the study is to evaluate the parameters of myocardial deformation and diastolic function of the left ventricle, as well as their interrelation with arterial hypertension in workers of the coal mining industry in the South of Kuzbass.Materials and methods. 384 people were examined (men), including 266 workers of coal mines in the South of Kuzbass (drifters, stope miners, operators of rock removing machines) and 118 persons who were not employed in the coal industry, aged from 40 to 55 years. Arterial hypertension was detected according to the clinical recommendations for the diagnosis and treatment of arterial hypertension in 2019. The structural and functional state of the heart was studied by echocardiography with evaluation of the longitudinal deformation of the left ventricle by 2D-strain method and its diastolic function using pulse-wave and tissue dopplerography.Results. The prevalence of persons with arterial hypertension in the group of workers employed in the coal industry was established: 43.2% against 26.3% in the comparison group (p=0.002). Longitudinal deformation of the left ventricular myocardium in all subjects was significantly less in the presence of high blood pressure: -21.0±0.18 vs. -19.2±0.22% (p&lt;0.001) in the main group and -21.54±0.22 vs. -19.84±0.38% (p&lt;0.001) in the comparison group. It should also be noted that there is a tendency to differ in subgroups of subjects without arterial hypertension towards a greater reduction in longitudinal myocardial deformation in coal miners (-21.54±0.22 and -21.0±0.18%, p=0.062). In miners, diastolic left ventricular dysfunction was significantly more common than in the group without occupational hazards: 52.5 and 39.3%, respectively, p=0.021. Its presence in the cohort of coal miners with arterial hypertension was detected significantly more often (58.9%) than in individuals with normal blood pressure (25.9%), p&lt;0.0001. In turn, in the group of people not employed in the coal industry, diastolic dysfunction of the left ventricle was also more common in the presence of arterial hypertension: in 42.6 and 13.9% of cases, respectively (p&lt;0.001).Conclusions. The incidence of arterial hypertension among coal miners was significantly higher than in people who do not work at coal mining enterprises. In all patients with arterial hypertension, the longitudinal deformation of the left ventricular myocardium with the preserved ejection fraction was lower than in those with normal blood pressure. Diastolic myocardial dysfunction of the left ventricle was significantly more common among those examined with underground working conditions, especially in the group of people with arterial hypertension.The authors declare no conflict of interests.

Spontaneous recovery of neuromuscular blockade is an independent risk factor for postoperative pulmonary complications after abdominal surgery: A secondary analysis.

In intermediate-to-high-risk patients, major abdominal surgery is associated with a high incidence of postoperative complications, mainly pulmonary. Neuromuscular blocking drugs have been suggested as a contributing factor, but this remains unproven. To define the relationship of neuromuscular blockade management (reversal) with postoperative pulmonary complications (PPCs). The individualised PeRioperative Open-lung approach Versus standard protectivE ventilation in abdominal surgery study was a prospective, multicentre, four-arm, randomised controlled trial. This is a secondary analysis of the data. Twenty-one teaching hospitals in Spain. The study was conducted between 2 January 2015, and 18 May 2016. Age more than 18 years with an intermediate-to-high risk for PPCs, scheduled for major abdominal surgery lasting more than 2 h. Exclusion criteria included pregnancy or breastfeeding, and moderate-to-severe organ diseases. The mode of reversal of neuromuscular blockade determined two patient groups: pharmacological reversal versus spontaneous recovery. The primary outcome was a composite of PPCs during the first 30 postoperative days. The association between categorical variables and PPCs within 30 days was studied. Univariate and multivariable logistic regression modelling and propensity score analyses were performed. From the 923 patients included, 596 (64.6%) presented with PPCs within 30 days after surgery. Patients who developed these complications were older with a higher BMI, a lower pre-operative SpO2, a higher ASA physical status score and a higher incidence of arterial hypertension, diabetes mellitus or chronic obstructive pulmonary disease. Pharmacological neuromuscular blockade reversal was associated with a lower incidence of PPCs (odds ratio 0.62, 95% CI 0.47 to 0.82). Spontaneous recovery of neuromuscular blockade was an independent risk factor for PPCs in patients with intermediate-to-high risk, undergoing abdominal surgery. We suggest this factor should be included in future studies on PPCs. clinicaltrials.gov identifier: NCT02158923.

Influence of operative treatment of variсocele on the development of arterial hypertension

Purpose of the research. To assess the incidence of arterial hypertension in men with varicocele and to identify the relationship between increased blood pressure and surgical treatment of varicocele.&#x0D; Material and methods. A survey of 412 men receiving treatment for arterial hypertension, 482 men previously operated on for varicocele and 68 patients with varicocele who had no surgical treatment was conducted.&#x0D; Results. Varicose veins of the spermatic cord in patients with arterial hypertension were detected in 44.6% of cases, which exceeds the incidence of varicocele occurrence in men of a comparable age category by 1.52 times. Surgical treatment of the left spermatic cord varicocele is combined with the development of arterial hypertension in 51.2% of patients, which is three times higher than the incidence of hypertension in men who didnt undergo surgical treatment for varicocele and twice the frequency of hypertension in the general population of men of comparable age. The more frequent occurrence of renal arterial hypertension in patients who underwent surgical treatment for varicocele may indicate an adverse effect of occlusion of the internal spermatic vein on the state of renal venous hemodynamics.&#x0D; Conclusion. Varicocele should be considered as a compensatory process for renal venous hypertension due to obstruction of blood flow through the renal vein, and elimination of compensatory blood flow can lead to renal venous hypertension, hypoxia and the development of arterial hypertension.

АРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯ И ФАКТОРЫ РИСКА У ДЕТЕЙ: ОБЗОР ЛИТЕРАТУРЫ

Background. In modern society, there is an intensive increase in the incidence of arterial hypertension among young people, which is mainly due to lifestyle characteristics and related risk factors.Objective: to analyze the results of scientific researches of domestic and foreign authors regarding the study of risk factors in the development of arterial hypertension in children.Material and methods. A qualitative analysis of the current literature data on the risk factors for arterial hypertension and its prevention has been carried out.Results. It has been established that the occurrence of arterial hypertension in childhood is due to not only hereditary, but also a number of environmental risk factors.Conclusions. Further researches are needed to study new and established risk factors that must be considered when conducting primary prevention of the disease in children at high risk.

High geographic prevalence of pulmonary artery hypertension: associations with ethnicity, drug use, and altitude.

While estimates of pulmonary arterial hypertension incidence and prevalence commonly range from 1–3/million and 15–25/million, respectively, clinical experience at our institution suggested much higher rates. We sought to describe the disease burden of pulmonary arterial hypertension in the geographic area served by our Pulmonary Hypertension Clinic and compare it to the REVEAL registry. Our secondary objectives were to document pulmonary arterial hypertension prevalence in minorities underrepresented in REVEAL (Hispanics and Native Americans) and to address the association of pulmonary arterial hypertension with exposure to drugs and moderately increased residential altitude in this population. Retrospective review of pulmonary arterial hypertension clinic patients alive during 2016 identified 154 patients. Hispanic patients made up 35.7% of the cohort, a much greater percentage than REVEAL, p < .001 but smaller than the percentage of Hispanic patients (48.4%) in geographic area served by the clinic. Pulmonary arterial hypertension due to drug exposure was more common and idiopathic pulmonary arterial hypertension was less common than in REVEAL (p < .001). Overall, pulmonary arterial hypertension incidence was 14 cases per million, greater than the REVEAL registry, odds ratio 6.3 (95% CI: 4.2–9.5), (p < .001). Annual period prevalence of pulmonary arterial hypertension was 93 cases per million, also greater than the REVEAL, odds ratio = 7.5 (95% CI: 6.4–8.8) and remained greater when the clinic cohort was constrained to patients with hemodynamic severity comparable to REVEAL, odds ratio = 3.8 (95% CI: 3.0–4.6), (p < .001). There was a strong association between pulmonary arterial hypertension prevalence and residence at altitude > 4000 ft, odds ratio = 26.6 (95% CI: 8.5–83.5), p < .001; however, this was potentially confounded by pulmonary arterial hypertension treatment referral patterns. These findings document a much higher local pulmonary arterial hypertension incidence and prevalence than previously reported in REVEAL. While population ethnicity differed markedly from REVEAL, the disease burden was not driven by these differences. The possible association of moderately increased residential altitude with pulmonary arterial hypertension warrants further evaluation.

CONTENTS OF MAGNESIUM IN THE ENVIRONMENT AND POPULATION MORBIDITY RATE OF ARTERIAL HYPERTENSION

Introduction. Study of the interrelation between magnesium content in biosphere objects (soil, natural water, plants) with arterial hypertension (AH) incidence among the population living in the territory of the plain Dagestan (Babayurtovsky, Kizlyar, Tarumovsky and Nogai districts of the Republic). material and Methods. To assess the development of hypertension, the data were obtained from the medical information center of the Ministry of Health of Dagestan. Samples of soil, water, plants with the determination of the magnesium content in them were processed by the photometric method in the biogeochemical laboratory of the Prikaspiyskiy Institute of Biology Resources of Daghestan Scientific Centre of the Russian Academy of Sciences. For analyzes, the material was selected in the summer months. The correlation coefficients are calculated by Pearson. Results. When comparing the incidence rates of AH for 2005-2007 with the magnesium content in soils, natural waters, plants, a negative average correlation of magnesium concentration in the study sites with the incidence of AH population was established in the study area. A number of patients in the studied years was also noted to be changing, but the dependence of the incidence of AH of the population on the magnesium content in the biosphere objects is preserved. Conclusions. One of the factors of occurrence and course of hypertension is the magnesium status of the population, which depends on the geochemical features of the territory. As a result of the study, it was found that the higher the magnesium content in biosphere objects, the lower the incidence of AH population. In order to reduce the AH values among the population, it is necessary to correct the lack of magnesium in the human body with magnesium additives, which contribute to the regulation of blood pressure and reduce the risk of cardiovascular diseases. In connection with the possible subclinical magnesium deficiency, an important factor in informing about the possible morbidity of hypertension is information on the magnesium content in environmental objects.

THE INFLUENCE OF ANNOYANCE DUE TO AIRCRAFT NOISE ON RENAL HEMODYNAMIC

Objective:Epidemiological evidence suggests a link between noise exposure and increased incidence of arterial hypertension and cardiovascular disease. The kidney as long-term regulator of blood pressure might play a role in the underlying pathophysiological mechanism. The aim of this study is to inv